Provider First Line Business Practice Location Address:
1277 NORTHFIELD RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CEDAR CITY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84720-8917
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-867-8175
Provider Business Practice Location Address Fax Number:
435-865-6379
Provider Enumeration Date:
09/21/2006